Healthcare Provider Details

I. General information

NPI: 1831169333
Provider Name (Legal Business Name): DEBORAH ANNE NOBILIO-VICARIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH ANNE NOBILIO-VICARIO MD

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10325 DEWHURST RD
ELYRIA OH
44035-8403
US

IV. Provider business mailing address

10325 DEWHURST RD
ELYRIA OH
44035-8403
US

V. Phone/Fax

Practice location:
  • Phone: 440-414-9260
  • Fax: 216-201-5581
Mailing address:
  • Phone: 440-414-9260
  • Fax: 216-201-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35075128
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: